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• . p � v�t t `�`• �� 1' <br /> ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App# <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME 1, /V ter Ada%; y/41= <br /> If N i�/r� 1/4 Akee E l ;eM/P�.4/o3 2 /Zoning Status;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) _„.,. G / Deed Restriction;CSM <br /> 515?? gtveSiz ?q-g_i P,Q,e 1`0 aivelI 4 Variance(# 352-5 ) <br /> HOME NONE CELL PHONE E-MAIL ADDRESS <br /> / '-3,e. ���7^7 <br /> I ./. a Site Plan drawn to scale <br /> AGENT INFORMATION CONTRACTOR INFORMATION and includes dimensions <br /> AGENT NAME / CONTRACTOR NAME <br /> 7r-0771i. Elidiry 5�l/1mA( U-fie 14r✓A irze ,I Site Plan including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS of well/s6 <br /> PO. /1v-(2 x815 (-- Lc . <br /> (City,State,Zip) (City,State,Zip) V Setbacks <br /> de,w 604-4 vs,&lir 5.351i- <br /> PHONE PHONE A Site Plan approval from <br /> (0)02 99- c9 8 ((aOS) 0279 - 0.7Pe3 applicable township. <br /> E-MAIL ADDRESS E-MAIL ADDRfS <br /> • CI'an nvA, / a s,n .gi Floor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: N. Elevation of property <br /> ❑ PARCEL ASil./_ �i 4 9 4 SF <br /> frontage drawn to scale. <br /> NUMBER (�/�/'� 7 <br /> TOWNSHIP: SECTION: <br /> (/j1/0\/ 36i -1/4: Ho) -1/4 : tia IS. Driveway permits <br /> ADDRESS: (state,county,town)a ib,,), o—c - Z55-4.19 <br /> S � � w-� �{i ../ --Z_ k Z 0 I <br /> CSM: LOT \SUBDIVISION BLOCK/LOT Sanitary permits <br /> 33 -f�5A ,f' ,his <br /> (public,private) <br /> PROPOSED PROJECT INFORMATION <br /> PROJECT DESCRIPTION: ,. <br /> iffew Xest/GNr#, t.. 6zN-t77 c1crto / <br /> This project is a new building or structure. <br /> A <br /> ❑This project is an addition/alteration to an existing building or structure. tee* :W <br /> _ <br /> SANITARY SERVICE: PERMIT NUMBER: ddre <br /> %SEWER ❑SEPTIC a <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not including basement) ' <br /> -.a z tiNIENlit <br /> 17 <br /> AREA TO NEAREST SQUARE FOOT: sue ¢ <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) <br /> BASEMENT: 1ST FLOOR: <br /> /7 g7r z2.6/ j TOTAL SQUARE FOOTAGE: j s ! • n r <br /> 2ND FLOOR: 3RD FLOOR: � "4-" t 0 <br /> ESTIMATED CONSTRUCTION COST: ♦ _I. ♦ ♦ _o. p 6 �c r , Q•t I <br /> (Please round to nearest dollar) $ � <br /> /74 QC <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? EYes LI No ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes ,'No ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? l?Yes ❑No <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? CI Yes ❑No <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal#.545- ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) A Yes ❑No ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes KiNo <br /> 2 <br /> 009 0% 7 <br /> r APPLICATION MUST BE SIGNED <br /> 545-112(4/08) (Continue on Back) ■ —I. —► <br /> Z .Z., roU <br />